Objective: The objective of this review is to present recent data on the mechanisms underlying toxic cardiomyopathy.
Methods: The US National Library of Medicine Pubmed database was searched from 1980 to December 2017 utilizing the combinations of the search terms “toxic cardiomyopathy”, “drugs”, “anticancer drugs”, “azidothymidine”, “rosiglitazone”, “carbon monoxide”, “alcohol”, “illicit drugs”, “cocaine”, “metamfetamine”, “metals”, “venom”. A total of 339 articles were screened and papers that dealt with the pathophysiology of toxic cardiomyopathy, either in animal models or in clinical practice were selected, with preference being given to more recently published papers, which left 92 articles.
Anticancer drugs: The mechanisms of anthracycline-induced cardiotoxicity are primarily related to their mechanisms of action as anticancer drugs, mainly the inhibition of topoisomerase II β and DNA cleavage. Additional metabolic or oxidative stress factors may play a part, together with interference with iron metabolism. The more recent drugs, trastuzumab and imatinib, also influence stress pathways.
Antiretroviral agents: Azidothymidine is cardiotoxic as a result of mitochondrial toxicity. In addition to energy depletion, azidothymidine also increases the production of mitochondrial reactive oxygen species (ROS).
Antidiabetic drugs: The cardiotoxicity of thiazolidinedione antidiabetic drugs is still under investigation, though interference with mitochondrial respiration or oxidative stress is suspected.
Cocaine: Among the multiple mechanisms involved in cocaine-related cardiotoxicity, excessive sympathetic stimulation with increased myocardial oxygen consumption is well documented in the acute form of left ventricular dysfunction. As for cocaine-related cardiomyopathy, the role of apoptosis and ROS is under investigation.
Ethanol: The aetiology of ethanol-related cardiotoxicity is multifactorial, with individual susceptibility being important. It involves apoptosis, alterations of the excitation–contraction coupling in cardiac myocytes, structural and functional alterations of the mitochondria and sarcoplasmic reticulum, changes in cytosolic calcium flows, changes in calcium sensitivity of myofilaments, alterations of mitochondrial oxidation, deregulation of protein synthesis, decrease of contractile proteins and disproportion between the different types of myofibrils, changes in the regulation of myosin ATPase, up-regulation of the L-type calcium channels, increase of oxidative stress, and induction of ANP and p21 mRNA expression in ventricular myocardium.
Metamfetamines: Catecholamine-mediated toxicity is the probable cause, with a possible role for genetic susceptibility.
Carbon monoxide: In addition to hypoxic injury, carbon monoxide is also directly toxic to the mitochondria, with impairment of mitochondrial respiratory chain at the cytochrome c oxidase level, decrease of glutathione concentrations and of ATP production. There is no evidence for a delayed dilated cardiomyopathy in survivors of an acute exposure.
Metals: Cobalt-related cardiomyopathy probably results from interference with energy production and contractile mechanisms, but additional factors (nutrition, hypothyroidism) are often required. Antimony may cause lethal oxidative stress and cell death mediated by elevation in intra-cellular calcium. Proposed mechanisms for mercury toxicity include glutathione depletion, production of ROS, and interruption in selenium-dependent endogenous enzymatic reactions. The existence of a lithium-induced cardiomyopathy is still debated.
Scorpion venom: Catecholamine release is the probable cause of acute cardiomyopathy following scorpion envenomation.
Conclusions: The mechanisms behind toxic cardiomyopathy are complex and multifactorial but include interference with myocardial cell bioenergetics and intracellular calcium handling, the generation of ROS, neurohormonal stress, and induction of apoptosis. 相似文献
Aim: To describe the assessment and interventions performed during nursing consultations.
Method: This is a quantitative, observational, and cross-sectional study.
Findings: In a convenience sample of 77 users, 52% are females, 43% are single, 52% do not possess any economic resources, 87% have mental health issues, and 32% are homeless. The main nursing focuses found were: arterial hypertension, disease management skills, and emotional suffering. The most used nursing intervention is listening, followed by the expression of feelings, valuing the individual and his/her story, analyzing causes, providing support, and comforting.
Conclusions: This study shows that the main focus of the nursing care in these facilities is the human being. The respect for individuality and dignity was the primary concern, in an attempt to empower the individual to better manage his/her health and illness processes. 相似文献
Areas covered: A thorough and extensive diagnostic approach is required for a correct diagnosis. The outcome has improved over the last decade with a better diagnostic approach and with the initiation of new targeted therapies. However, there is still significant progress to achieve as there is still no cure for this devastating disease.
Expert opinion: Adapted clinical studies to define the best therapeutic approach are needed. Even if the treatment approach is still mainly derived from adult data and expert consensus, several studies and registries are currently underway and should deliver important information in the next future.
This review aims to give an overview of the current diagnosis and treatment strategies of PAH. 相似文献
Aims of Study: This study aimed to assess university students’ knowledge and beliefs about and their use of antibiotics.
Methods: This cross-sectional study was conducted among 674 medical and non-medical students of the National Defence University of Malaysia, using universal and convenience sampling methods. The data was collected using a validated questionnaire and analyzed using IBM SPSS 24, and the MANOVA test and Logistic Regression were used to explore the associated factors.
Results: More than half of the respondents’ knowledge was low and their health beliefs outdated. Age, race and program were significantly associated with up-to-date knowledge and beliefs about antibiotic use, factors associated with finishing a course of antibiotics were studying medicine, personal health, and ethnicity. The significant factors associated with antibiotic self-prescribing were beliefs having been prescribed antibiotics during the last one year, and trusting the doctors who did not prescribe antibiotics.
Conclusion: This study has identified a concerning low knowledge about antibiotics amongst some Malaysian university students, reflected in use of un-prescribed antibiotics and a lack of adherence to treatment. There is a need for educational interventions for students regarding antibiotic usage and resistance issues. 相似文献
Aims: To determine whether there are differences among urine-screened cannabis-only users, polysubstance users using cannabis, and nonusers on the number of inpatient hospitalizations and length of stay for patients with schizophrenia or schizoaffective disorder.
Method: This study (N = 116) included patients who tested positive for only cannabis (n = 20, Group 1); tested positive for cannabis and had a history of other substance use (n = 43, Group 2); and had negative drug screens (n = 53, Group 3).
Results: Groups 1 and 2 had significantly lower numbers of hospitalizations than Group 3 without controlling for any other factors, and non-significantly lower lengths of stay than Group 3.
Conclusions: Our results do not support the hypothesis that cannabis exacerbates psychotic symptoms in patients with schizophrenia or schizoaffective disorder. Our study is unique in that it utilized objective urine drug screens. 相似文献
Material and methods: The main outcome measures were duration of surgery, intraoperative bleeding quantity, complications, post-operative pain scores, additional analgesic requirements, and length of hospital stay.
Results: A total of 53 women, 28 in the conventional laparoscopy group and 25 in the SILS group, participated in the study. There were no differences in demographic characteristics between the two groups. There were no differences in terms of variables including gestational week, beta human chorionic gonadotropin (βhCG) levels, and operation time. No intraoperative complications were observed in either group. The groups exhibited no significant differences regarding additional analgesic requirements or postoperative pain scores. However, pain at the sixth postoperative hour was lower in the SILS group. This effect was not observed at 12 and 24?hours.
Conclusion: SILS appears to be effective and safe for the treatment of ruptured ectopic pregnancies accompanied by hemoperitoneum. 相似文献
Methods: PubMed, EMBASE, and Web of Science (SCI) databases were systemically searched until December 2017. Observational studies comparing the incidences of insulin resistance in patients with early, average, and late menarchal ages were identified. Weighted mean difference (WMD) for HOMA-IR scores and fasting serum insulin levels in early vs late, early vs average. and average vs late comparisons were calculated with a random- or fixed-effects model.
Results: A total of eight articles involving 5504 subjects were finally included. In the analysis of HOMA-IR, the pooled WMDs in five studies were 0.45 (95% confidence interval [CI] 0.31–0.60, p < 0.001), 0.40 (95% CI 0.28–0.52, p < 0.001), and ?0.01 (95% CI ?0.09 to 0.07, p = 0.854) for early vs late, early vs average, and average vs late comparisons, respectively. The fasting serum insulin levels in eight studies were analyzed, and it was significantly higher in subjects with earlier age at menarche (WMD 1.28, 95% CI 0.92–1.63, p < 0.001 for early vs late comparison, WMD 1.28, 95% CI 1.13–1.43, p < 0.001 for early vs average comparison) with mild and acceptable heterogeneity (I2 = 42.5% and 7.4%, respectively). Publication bias was not detected via funnel plots and Egger’s tests.
Conclusions: Our study revealed that earlier age at menarche was significantly associated with insulin resistance.
Trial Registration Number: CRD42018083874 相似文献
Design: A cross-sectional study.
Setting: Occupational health care in the region of Pori, Finland.
Subjects: 671 municipal employees (89% females) with a mean age of 49 (SD 10) years. Information about the study subjects was gathered from medical records, by physical examination and questionnaires containing information about physical and mental health, health behavior, work-related and sociodemographic factors. The number of sickness absence days was obtained from the records of the city of Pori.
Main outcome measures: The relationship of absenteeism rate with sociodemographic, health- and work-related risk factors.
Results: In the multivariate analysis, the mean number of chronic diseases (IRR 1.24, 95% CI 1.13 to 1.36), work ability (IRR 0.83, 95% CI 0.76 to 0.91), and length of years in education (IRR 0.90, 95% CI 0.85 to 0.95) remained as independent factors associated with absenteeism.
Conclusion: According to our results, chronic diseases, self-perceived work ability and length of years in education are the most important determinants of the rate of sickness absence. This implies that among working-aged people the treatment of chronic medical conditions is also worth prioritizing, not only to prevent complications, but also to avoid sickness absences.
- KEY POINTS
Various sociodemographic, health- and work- related risk factors have been shown to influence sickness absence.
The study aimed to find the most important determinants of absenteeism among several known risk factors in Finnish municipal employees.
Chronic diseases, self-perceived work ability and education years remained as the most important determinants of sickness absence rates.
Treatment of chronic medical conditions should be prioritized in order to reduce sickness absence rate.
Design: A qualitative study employing a participatory design approach, with an inductive analytical thematic approach utilising semi-structured interviews. Empirical data was analysed using the qualitative data analysis software (QDAS) Nvivo.
Setting: General practices in Denmark.
Subjects: Eight interviews were conducted with an average duration of 60?min. The interviewees were GPs from different geographical settings and different organisational structures, varying in age and professional interests.
Main outcome measures: Barriers and facilitators for future use of the HIT application for patients with LBP.
Results: Through the inclusion of healthcare professionals in the design process, this study found that in order for GPs to recommend a HIT application it is essential to target the application towards their patients. Furthermore, GPs required that the HIT application should support patient self-management. Additionally, the content of the HIT application should support the initiated treatment and it should be easy for GPs to recommend the HIT application. Finally, healthcare professionals need to be involved in the design process.
Conclusion: When designing health IT applications for patients with LBP in general practice it is important to include both patients and GPs in the design process. GPs would be more willing to recommend a HIT application that: applies content in line with frequently used recommendations; targets patients; supports patients’ self-management; and supports the patients’ needs.
- KEY POINTS
Online information is currently applied in general practice to some patients with low back pain
Online information cannot replace the GP, but can rather be a bonding tool between the patient and the GP
It is important to address both GP and patient barriers to applying new technology and to consider the literacy level
Participatory methods could play a central role in the future development of online information material
Design: Interviews. Latent qualitative content analysis.
Setting: Nine nursing homes in Sweden.
Subjects: 14 physicians and 11 nurses working at nursing homes.
Main outcome measures: Participants’ views on advance care planning (ACP) at nursing homes.
Results: The analysis of the interviews resulted in four manifest categories: Exploration of preferences and views, e.g. exploring patient wishes regarding end-of-life issues and restrictions in care at an early stage, and sensitivity to patient’s readiness to discuss end-of-life issues; Integration of preferences and views, e.g. integration of patient’s preferences and staff’s and family member’s views; Decision & documentation of the ACP, e.g. clear documentation in patient’s medical records that are up-to-date and available for staff caring for the patient, and Implementation & re-evaluation of the ACP, e.g. nurse following up after ACP-appointment to confirm the content of the documented ACP. The latent theme, Establishing beneficence – defending oneself against tacit accusations of maleficence, emerged as a deeper meaning of all the four (manifest) parts of the ACP-process
Conclusion: This study stresses the importance of involving patients, family members, and the team in the work with advance care planning in nursing homes. In addition, clear medical record documentation and proficiency in end-of-life communication related to advance care planning for physicians as well as nurses may also be factors that significantly shape advance care planning in a nursing home context.
- Key Points
Advance care planning can help patients to receive care in line with their preferences and can positively impact quality of end-of-life care.
Our results describe a process consisting of four manifest categories and one latent theme constituting the process of advance care planning, that may be considered in education in advance care planning.
The significance of nurses and physicians perceiving beneficence as well as fear of accusations of maleficence are important factors to contemplate.
The study has implications for healthcare staff caring for patients near the end of their lives, in particular patients in nursing homes.
Objective: The aim of this study was to translate and adapt the scale and to test the translated version for comprehension and suitability in Danish general practice setting.
Design and method: The process involved forward translation, backward translation, and field tests. The field tests included cognitive debriefing interviews. In all 30 general practitioners and 5 non-general practitioners participated in the process of translation. After using the scale among 1652 general practitioners statistical analysis was carried out to test internal consistency.
Setting: The study was carried out in general practice in Denmark.
Results: Several changes made during the process in order to achieve a Danish version that is acceptable, understandable and still capable of measuring medical engagement comparable of the original English version. Analysis of scale internal consistency using Cronbach’s alpha revealed acceptable reliability for all three meta-scales, which ranged from 0.69 to 0.81. The overall tool achieved a Cronbach’s alpha of 0.89.
Conclusion: The Danish version of the Medical Engagement Scale is a valid and reliable tool that is acceptable and relevant for general practice in Denmark.
- Key points
This study describes the cross-cultural adaptation of the Medical Engagement Scale from a UK primary healthcare setting to a Danish primary healthcare setting.
The process produced a relevant and acceptable questionnaire measuring medical engagement.
Internal consistency revealed acceptable reliability
The translation of the scale provides the possibility to use this scale for practical and academic purposes.
Methods: Extensive literature searches were conducted between June 2015 and March 2018. Articles meeting the inclusion criteria were identified, systematically extracted and quality assessed using the critical appraisal skills program.
Results: Fifteen articles with 26 outcome analysis on behavioral and psychological symptoms (n?=?12), depression and/or mood (n?=?9) and quality of life (n?=?5) were included in this review. AAI reduced behavioral and psychological symptoms in 6 of 11 articles, reduced depression and/or improved mood in 6 of 9 articles, and improved quality of life in 3 of 5 articles.
Conclusions: AAI by dogs or robotic animals is promising in reducing behavioral and psychological symptoms and depression, and improving mood and quality of life among residents with dementia living in nursing homes. 相似文献
Design: The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs.
Setting: OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation.
Patients: Audio-recorded OOH patient contacts.
Main outcome measures: Test-retest and inter-rater reliability were analysed using ICCagreement, Fleiss’ kappa and percent agreement.
Results: Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage – AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICCagreement reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICCagreement and in Fleiss’ kappa. Percent agreement revealed satisfactory agreements when differentiating between ‘poor’ and ‘sufficient’ quality).
Conclusion: The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between ‘poor’ and ‘sufficient’ quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT.
- KEYPOINTS
Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses.
The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners
AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency.
AQTT can be used to identify areas for improvement in telephone triage
Design: Prospective diagnostic study using paired samples.
Setting/Intervention: Three general practices in Copenhagen. Each woman delivered FVU and MSU samples from the same void. As a reference standard, 8?ml of MSU was sent for culture at the Microbiology Department.
Patients: 117 women with one or more symptoms of UTI.
Main outcome measures: Sensitivity, specificity and agreement with the reference standard of FVU and MSU with different time delays (zero vs. one vs. four hours) as compared to reference standard (MSU at time zero in boric acid tubes).
Results: All three POC tests performed on MSU were significantly more in agreement with the reference than when performed on FVU when analysis was done immediately. The error rate was 16% for MSU vs. 23% for FVU with POC culture, 27% vs. 40% with microscopy and 25% vs. 33% with dipstick testing. Delay of analysis up to four hours did not decrease agreement with the reference.
Conclusion/Implication: MSU samples should be used in general practice for optimal accuracy of POC tests. Analysis can be delayed up to four hours.
- Key points
Point-of-care tests (dipstick testing, microscopy and culture) for diagnosing urinary tract infection performed on mid-stream urine samples are significantly more accurate than when performed on first-void urine samples.
Delay of analysis up to four hours did not decrease the accuracy of any of the point-of-care tests.
Point-of-care culture was more accurate than dipstick and microscopy both when performed on mid-stream urine and first-void urine
The main contaminant in first-void urine samples was Enterococci spp., which contributed to the majority of false positives.
Design: Qualitative semi-structured interviews with 20 GPs working in Swedish primary care. A thematic analysis of the transcribed material was carried out to map different techniques employed by the practitioners.
Results: Eight techniques were identified, particularly with respect to the way in which the sickness certificate is written to ensure approval by the SSIA. The identified techniques were most commonly adopted when the patient’s case was perceived to be at high risk for rejection by the SSIA (such as psychiatric illnesses, chronic pain etc.).
Conclusions: The findings imply that the informal and unsanctioned techniques are complex and ambiguous. They are used intentionally and covertly. The study also suggests that, while the consolidation of SSIA’s gatekeeping role may have resolved some sickness absence issues, a consequence may be that GPs develop unsanctioned techniques to ensure compliance. 相似文献
Objective: This study seeks to evaluate the effectiveness of universal screening using a direct approach self-report of substance use in pregnancy.
Method: A retrospective review of de-identified data to evaluate women’s willingness to self-report substance use through direct screening. Data obtained from 24 months of maternal self-report were analyzed to assess the overall effectiveness of a direct screening method during the prenatal period.
Results: Findings revealed maternal substance use disclosure rates of 9.7%, higher than the 5.4% United States national average.
Conclusion: Increasing awareness of maternal prenatal substance use offers opportunity for education and support early in pregnancy. Findings suggest the direct method may support maternal self-report of substance use in universal prenatal screening. Additional study with diverse populations and clinical settings is needed. 相似文献
Objectives: The study proposes that substance misuse and recovery can be understood from an Agency-Communion perspective.
Method: The Life As A Film Task (LAAF) and repertory grids were used to explore Agency and Communion in a sample of 32 participants.
Results: Smallest Space Analysis of LAAF items revealed four different narratives according to themes of Agency and Communion. Case examples indicated that Agency and Communion predicted a recovery identity, and the absence of Agency and Communion predicted substance misuse. Analysis of repertory grids showed fixed low Agency/Communion construct systems in cases of substance misuse and transformed high Agency/Communion construct systems in cases of recovery. Transformation from a low Agency/Communion substance-using identity toward a high Agency/Communion recovery identity was highlighted.
Conclusions: These preliminary findings illustrate the role of Agency and Communion processes in identity-transforming recovery from substance misuse. 相似文献
Methods: Twenty-four asymptomatic participants (maleness: 0.58, age [mean ± standard deviation]: 32 ± 8 years, body mass index 25.9 ± 2.6 kg m2) were recruited to a fully controlled crossover trial. Following either the intervention (L4/5 zygapophyseal mobilizations) or control, participants immediately performed the AKE and ALF tests, which were also performed at baseline. Subsequent tests were made at intervals of 5, 10, 15, 20, 25, 30, 45 and 60 min.
Results: After adjustment for baseline (mean AKE: 37.2° from full extension, mean ALF: 14.37 cm), sex and age, UPA lumbar mobilizations had a most likely moderate effect on AKE (9.8° closer to full extension; ±1.9) and a likely moderate effect on ALF (1.34 cm; ±90% confidence limits 0.43). The magnitude of the AKE effect became most likely small 20-min posttreatment (5.3; ±1.7) and possibly small/possibly trivial 60-min posttreatment (2.1; ±1.4). For ALF, the magnitude of the effect became most likely small 15-min posttreatment (0.76; ±0.25), possibly small/possibly trivial 25-min posttreatment (0.38; ±0.18) and likely trivial 60-min posttreatment (0.26; ±1.8).
Discussion: UPA lumbar mobilizations increased lumbar Range of Motion and hamstring extensibility by a moderate magnitude, with the effect reducing after 10–20-min posttreatment. Clinicians should consider these time-course changes when applying UPA lumbar mobilizations.
Clinical Trials Registry: NCT03273400
Evidence Level: 2b 相似文献
Methods: Ten nurses were involved in 130 simulated PCP call scenarios, allowing the determination of SALOMON’s inter-rater agreement by comparing the actual choices of a specific triage flowchart and the level of care selected as compared with reference assignments. Intra-rater agreement was estimated by comparing triage after training (T1) and 3 to 6 months after SALOMON use in clinical practice (T2).
Results: Overall selection of flowcharts was accurate for 94 .1% of scenarios at T1 and 98.7% at T2. Level of triage was adequate for 93.4% of scenarios at T1 and 98.5% at T2. Both flowchart and triage level accuracy improved significantly from T1 to T2 (p?<?0.0001). SALOMON algorithm use is associated with a 0.97/0.99 sensitivity and 0.97/0.99 specificity, at T1/T2 respectively.
Conclusions: Results revealed that using the SALOMON algorithm is valid for out-of-hours PCP calls triage by nurses. The criterion validity of this algorithm should be further evaluated through its implementation in a real life setting. 相似文献